GENERAL30360

• Permit No: C1981047
• IBM Index Class Name: General Documents
• Doc Date: 5/21/2003
• Doc Name: Certificate of Liability Insurance
• To: DMG
• Permit Index Doc Type: Insurance
• Media Type: D
• Archive: No

ACORD CERTIFICATE OF LIABILITY INSURANCES OP ID DATE (MM/DD/YY)
EMCO-1 05/19/03
PRODUCER a, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Blanchard Insurance Group Inc . RE~EIV ED ALOTER THE COCERAGE AFFORDED BOY THE O CIESEBE OW:
P:O: Box 60130 -- - nG
Grand Junctioa CO 81506 c
Phone: [phone] Fax:970-245- ~~ 2 1 2~ INSURERS AFFORDING COVERAGE
INSURED SURERA Employers Mutual Casualty Co.
Division of Minerals and Geol
INSURER B:
SEM Coastructign CO. INSURER C:
715 Horizon Drive, Suite 219 INSURER D:
Grand Junction CO 81506
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOW N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE POLICY NUMBER GATE MMID DATE MMIDD/YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1, OOO, QQQ
A X COMMERCIAL GENERAL LIABILITY 9X90868 05/10/03 OS/10/04 FIRE DAMAGE (Any one fire) § 100, QQQ
CLAIMS MADE OCCUR MED EXP (Any one parson) $ $,QQQ
PERSONAL aADV INJURY $1,000,000
GENERAL AGGREGATE §2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG §2, QQQ,QQQ
POLICY PEC0. LOC
AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT
000
$1
000
A X ANV AUTO 9X90868 05/10/03 05/10/04 (Ea accident) ,
,
ALL OW NED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE

(Par accident) $
GARAGE LIA8ILT' AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG §
EXCESS LIABILITY EACH OCCURRENCE $

OCCUR ~ CLAIMS MADE AGGREGATE $

DEDUCTIBLE E
RETENTION $ $
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS' LIABILRY
_
`
_ _ _ __
_ _ _
_E.L. EACH ACCIDENT
§
E.L. DISEASE-EA EMPLOYE $
E.L. DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATX)NS20CATIONSNEHICLES/EXCLUSIDNS ADDED 8Y ENDORSEMENT/SPECIAL PROVISIONS
RE: Slue Ribbon Mine-File No C-81-047. State Of Colorado, Division Of
Miaerala & Geology is included as an Additional Insured.*10 Days Notice Due
to Noa-Paymeat Of Premium.**Or incur substantive changes or failure to
renew.
CERTIFICATE HOLDER N ADDRIONAL INSURED; INSURER LETTER: _ CANCELLATION
DOOOOOO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
State Of Colorado DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTO MAIL *30 DAYS WRNTEN
DSViSiOn Of Minerals & GEIOlOgy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
1313 Shermaa StrBet ROOM 21S IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Denver CO 80203
REPRESENTATIVES. e
ACORD 25-S (T/97) / C~iACORD CORPORATION 1988